Comparing Health Insurance Measurement Error (CHIME)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
supporting_statement_b_FINAL.doc	Supporting Statement B	Uploaded 2015-05-05	Available
supporting_statement_a_FINAL.doc	Supporting Statement A	Uploaded 2015-05-05	Available
pre_submission_notice.doc	Supplementary Document	Uploaded 2015-05-05	Available
white_paper_FINAL.doc	Supplementary Document	Uploaded 2015-05-05	Available
advanceletter_MedicaFinal_v2.pdf	Supplementary Document	Uploaded 2015-05-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216428	Comparing Health Insurance Measurement Error (CHIME)	Other-CHIME March 2015 Draft Questionnaire	New

ICR Details

OMB Control No: 0607-0983	ICR Reference No: 201505-0607-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOC/CENSUS	Agency Tracking No:
Title: Comparing Health Insurance Measurement Error (CHIME)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/14/2015
	Date Received in OIRA: 05/12/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	36 Months From Approved
Responses	5,000	0	0
Time Burden (Hours)	1,083	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Economic Supplement (CPS) and the American Community Survey (ACS) by comparing survey reports to data from administrative records from the Medica Health Plan in Minnesota. The survey will be conducted by telephone with sample of Medica enrollees. The data will inform efforts to reduce misreporting of coverage in the CPS and ACS and, more generally, to understand measurement error in surveys that measure health insurance. A single household respondent (18 and over) will be asked to answer questions about all other household members.

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Authorizing Statute(s): US Code: 13 USC Sections 141, 182 and 193 Name of Law: Title 13
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 68405	11/17/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 8473	04/14/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Comparing Health Insurance Measurement Error (CHIME)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	5,000	0	0	5,000	0	0
Annual Time Burden (Hours)	1,083	0	0	1,083	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $336,530

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/12/2015

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